SURGERY. 721 SURGERY. tive methods in the Spanish-American War the percentage of recoveries was 95.1 per cent., while 4.9 per cent, died, a ratio never before attained in the history of warfare. The medical corps of different armies vary lit- tle in their personnel. There is one surgeon-gen- eral; a chief surgeon to each separate army corps, division, brigade, and general hospital ; a surgeon and two assistants to each regiment ; and a single surgeon with each battery or separate detachment. These are all commissioned officers. The hospital corps comprises the hospital stew- ards ami their assistants, privates often selected to serve as pharmacists, orderlies, nurses, cooks, litter-bearers, and ambulance-drivers, and should equal four per cent, of the fighting force of the army. In addition to a canteen, the United States Hospital Corps men carry a corps pouch and an orderly pouch. The corps pouch contains aromatic spirits of ammonia, first dressing packets, wire gauze for splints, gauze bandages, rubber band- ages, surgical plaster, scissors, pins, forceps, and knife. The orderly pouch contains chloroform, antiseptic tablets, j^ocket case, ligatures, hypo- dermic syringe, etc. iMedical and surgical chests used on the march or at the front should contain, as stated by Surgeon-General Forward. United States Army, "surgical material mainly, and very little medicine, which may be for the most part in talilet form. The principal articles are splints and modern wound dressings, including plaster rollers, and rubber plaster for rapid fixation of splints; a light complete operating set, tin trays, basins, and cups in nests; chloro- form and inlialer; rubber tubing, needle, and canula; and pure sodic ehlorid for transfusion; mercuric bichlorid, tricresol, iodoform, soda, and green soap ; rubber bandage and rubber gloves ; hypodermic syringe and full sets of tablets ; purgative pills, quinine, and a few other medi- cines; concentrated food and stimulants; small case of 'tools in the handle,' and a lantern. The dressings consist mostly of biclilorid and iodo- form gauze, absorbent cotton, and gauze band- ages. They should be in small parcels, compressed, and wrapped in strong waterproof paper, to save waste and contamination, and for convenience in transportation, handling, and distribution." The same general directions — relative to (1) the operating room, covering instruments and dressings ; ( 2 ) preparation of the patient : ( 3 ) preparation of the surgeons: (4) the operation: and (5) after-treatment — that apjtly in general surgery (as stated in the article Si'RGERV) apply also to military surgery at the base hospitals, and siiccessful results will follow in exact pro- portion as these details are carried out. It is not therefore to any special training in surgical technique that the military surgeon will owe his triumphs. History has shown that more cam- paigns have been decided by disease than by the sword. Statistics of wars for the past hundred years, while varying in some particulars, have concurred to establish the fact that for every soldier killed in battle there are five wounded who recover. The introduction of modern wea- pons with the compound metal-Jacketed small- calibre balls of high velocity and great range, has shown no perceptible change in the propor- tion of these figures, viz. one killed to five wounded. It is also an established fact that for every man killed in action or who dies from the results of wounds, at least five die of disease that is almost invariably of a preventable char- acter. In the American Civil War (1801-65) 1111,070 were killed, and over 249,458 died from disease. These proportions were higher in the war of the Crimea and also in the Slexican War; and in the Spanish-American War, although ac- tual hostilities only lasted for a period of six weeks, the proportion of losses by disease was even higher still. When these appalling figures are properly rec- ognized, and the advantages of extreme conserva- tion on the field is appreciated, the true field of the military surgeon will be found. He must possess executive ability and a certain amount of military training, so that in time of action he can quickly organize his assistants and hospital corps, seeing that the wounded are brought promptly from the firing line to the first dressing station. This should be located at the nearest protected spot to the firing line. Here the wounded man can receive such immediate atten- tion by the surgeon or an assistant as is im- peratively demanded ; dressings if out of place can be readjusted; in case of fractures or joint injuries the limb can be immobilized in splints, and the soldier can rest until transported by ambulance or otherwise to the field hospital, which should be located well in the rear. Here the case can receive thorough attention, and later be transported to a general or base hospital, a hospital ship, or a civil hospital, as is deemed most advisable. The problem of rapid transpor- tation of the wounded is one that should engage much attention. Splendid results in the develop- ment of this feature were attained in the war with Spain, by the hospital ships and fast rail- way train in charge of the surgeons of the Ameri- can Army, and many valuable lives were saved in consequence. But it is at times when the army is not in action that the responsibilities of the military surgeon are greatest. In order to prevent the in- vasion of that deadlier foe, whose fatalities in every year are never less than five times greater than those killed in battle, he must prove himself a keen sanitary engineer in the selection of camp sites, of camp drainage, of the location of lat- rines ; in the inspection of all water supplies, the quality of food and its cooking, and of the soldier's clothing and liis personal cleanliness. He must be an epidemiologist and a bacteriologist, as well as a student of dietetics and metabolism. Terrible epidemics of t.yphoid fever, cholera, dys- entery, and diarrhoea have resulted from flies car- rying disease germs from unsavory places to the mess-hall, or through the drinking of polluted water. The parasite of malaria and of yellow fever is transmitted through the medium of the mosquito, that of tuberculosis through the sputum. ( See Insects, Prop.gation of Disease by). The iron-clad ration of the soldier has at times led to starvation or scurvy, or has proved an excitant to intestinal disease. With all these problems the military surgeon must be prepared to wrestle, especially when he is with newly recruited troops, unaccustomed to the rigorous discipline of army life, or when sta- tioned in tropical climes. 'The normal condition of the soldier is health; disease and premature death are to a large extent unnecessary. "They are to be overcome, however, not by the abroga- tion of the intellectual faculty, but by its exer- cise."
